Warfarin counselling

Question 1

Contraindications

Answer 1

• Pregnancy
• Significant risk of major bleeding
• Active bleeding

Question 2

How the treatment works

Answer 2

• Thins the blood to treat or prevent blood clots
• It does this by blocking vitamin K - the vitamin used by the body to make proteins that cause the blood to clot

Question 3

Treatment course and how its taken

Answer 3

• Once daily tablet (usually in the evening)
• Usually prescribed for 3 months for a DVT, 6 months for a PE, and lifelong for AF
• Dose changes take 2-3 days to take effect

Question 4

Monitoring required

Answer 4

• Started at 5mg each evening
• INR on days 3,4 and 5 - warfarin dosing charts tell you how to adjust the dose
• Then regular INR checks by anticoagulation clinic - regularity determined by INR stability (patient will be given anticoagulation book)

Question 5

Monitoring required

Answer 5

• Started at 5mg each evening
• INR on days 3,4 and 5 - warfarin dosing charts tell you how to adjust the dose
• Then regular INR checks by anticoagulation clinic - regularity determined by INR stability (patient will be given anticoagulation book)

Question 6

Side effects

Answer 6

• Bleeding - seek medical advice if you have significant head injury, prolonged nose bleeds, unusual headaches, blood in urine/stool/vomit, black stool, unexplained or severe bleeding
• Also diarrhoea, rash, hair loss, nausea
• Many interactions (mostly with P450 cytochrome inducers/inhibitors) - patients should avoid liver, spinach, cranberry juice, alcohol binges, NSAIDs/aspirin